[Thrombolytic therapy in deep vein phlebitis of the lower limbs]

Intravenous heparin is still the basic treatment of deep vein thrombosis in the lower limbs. However, its weak action on the blood clot and its poor efficiency in the prevention of functional sequelae have resulted in its replacement by thrombolytic agents. Streptokinase produces a more than 50 percent lysis of the thrombus 4 times more frequently than heparin, but the result depends on the degree of venous occlusion and on the site and duration of the thrombosis. The risk of pulmonary embolism does not seem to be increased, but haemorrhagic accidents are 3 times more frequent than with heparin. The long-term benefit on functional venous sequelae is questionable, the best results being obtained by an early treatment with complete recanalization of the vein and absence of recurrence. The value of thrombolytic agents in the treatment of deep vein thrombosis has therefore not been demonstrated, but they can reasonably be prescribed to young patients with recent proximal and non-occlusive phlebitis.